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Multivessel vs. culprit-only revascularization in patients with non-ST-elevation acute coronary syndromes and multivessel coronary disease.
Rev Port Cardiol. 2018 Feb; 37(2):143-154.RP

Abstract

INTRODUCTION

There have been no prospective randomized trials that enable the best strategy and timing to be determined for revascularization in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and multivessel coronary artery disease (CAD).

OBJECTIVES

To compare short- and long-term adverse events following multivessel vs. culprit-only revascularization in patients with NSTE-ACS and multivessel CAD.

METHODS

This was a retrospective observational study that included all patients diagnosed with NSTE-ACS and multivessel CAD who underwent percutaneous coronary intervention (PCI) between January 2010 and June 2013 (n=232). After exclusion of patients with previous coronary artery bypass grafting (n=30), a multivessel revascularization strategy was adopted in 35.1% of patients (n=71); in the others (n=131, 64.9%), only the culprit artery was revascularized. After propensity score matching (PSM), two groups of 66 patients were obtained, matched according to revascularization strategy.

RESULTS

During follow-up (1543±545 days), after PSM, patients undergoing multivessel revascularization had lower rates of reinfarction (4.5% vs. 16.7%; log-rank p=0.018), unplanned revascularization (6.1% vs. 16.7%; log-rank p=0.048), unplanned PCI (3.0% vs. 13.6%; log-rank p=0.023) and the combined endpoint of death, reinfarction and unplanned revascularization (16.7 vs. 31.8%; log-rank p=0.046).

CONCLUSIONS

In real-world patients presenting with NSTE-ACS and multivessel CAD, a multivessel revascularization strategy was associated with lower rates of reinfarction, unplanned revascularization and unplanned PCI, as well as a reduction in the combined endpoint of death, reinfarction and unplanned revascularization.

Authors+Show Affiliations

Escola de Ciências da Saúde, Universidade do Minho, Braga, Portugal.Serviço de Cardiologia, Hospital de Braga, Braga, Portugal. Electronic address: carlos.galvaobraga@gmail.com.Serviço de Cardiologia, Hospital de Braga, Braga, Portugal.Serviço de Cardiologia, Hospital de Braga, Braga, Portugal.Serviço de Cardiologia, Hospital de Braga, Braga, Portugal.Serviço de Cardiologia, Hospital de Braga, Braga, Portugal.Serviço de Cardiologia, Hospital de Braga, Braga, Portugal.Serviço de Cardiologia, Hospital de Braga, Braga, Portugal.Serviço de Cardiologia, Hospital de Braga, Braga, Portugal.Serviço de Cardiologia, Hospital de Braga, Braga, Portugal.

Pub Type(s)

Comparative Study
Journal Article
Observational Study

Language

eng por

PubMed ID

29486987

Citation

Correia, César, et al. "Multivessel Vs. Culprit-only Revascularization in Patients With non-ST-elevation Acute Coronary Syndromes and Multivessel Coronary Disease." Revista Portuguesa De Cardiologia : Orgao Oficial Da Sociedade Portuguesa De Cardiologia = Portuguese Journal of Cardiology : an Official Journal of the Portuguese Society of Cardiology, vol. 37, no. 2, 2018, pp. 143-154.
Correia C, Galvão Braga C, Martins J, et al. Multivessel vs. culprit-only revascularization in patients with non-ST-elevation acute coronary syndromes and multivessel coronary disease. Rev Port Cardiol. 2018;37(2):143-154.
Correia, C., Galvão Braga, C., Martins, J., Arantes, C., Abreu, G., Quina, C., Salgado, A., Álvares Pereira, M., Costa, J., & Marques, J. (2018). Multivessel vs. culprit-only revascularization in patients with non-ST-elevation acute coronary syndromes and multivessel coronary disease. Revista Portuguesa De Cardiologia : Orgao Oficial Da Sociedade Portuguesa De Cardiologia = Portuguese Journal of Cardiology : an Official Journal of the Portuguese Society of Cardiology, 37(2), 143-154. https://doi.org/10.1016/j.repc.2017.05.010
Correia C, et al. Multivessel Vs. Culprit-only Revascularization in Patients With non-ST-elevation Acute Coronary Syndromes and Multivessel Coronary Disease. Rev Port Cardiol. 2018;37(2):143-154. PubMed PMID: 29486987.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multivessel vs. culprit-only revascularization in patients with non-ST-elevation acute coronary syndromes and multivessel coronary disease. AU - Correia,César, AU - Galvão Braga,Carlos, AU - Martins,Juliana, AU - Arantes,Carina, AU - Abreu,Glória, AU - Quina,Catarina, AU - Salgado,Alberto, AU - Álvares Pereira,Miguel, AU - Costa,João, AU - Marques,Jorge, Y1 - 2018/02/25/ PY - 2017/01/30/received PY - 2017/04/09/revised PY - 2017/05/03/accepted PY - 2018/3/1/pubmed PY - 2018/12/20/medline PY - 2018/3/1/entrez KW - Doença coronária multivaso KW - Multivessel coronary disease KW - Multivessel revascularization KW - Non‐ST‐segment elevation acute coronary syndrome KW - Propensity score matching KW - Revascularização multivaso KW - Síndrome coronária aguda sem supradesnivelamento do segmento ST SP - 143 EP - 154 JF - Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology JO - Rev Port Cardiol VL - 37 IS - 2 N2 - INTRODUCTION: There have been no prospective randomized trials that enable the best strategy and timing to be determined for revascularization in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and multivessel coronary artery disease (CAD). OBJECTIVES: To compare short- and long-term adverse events following multivessel vs. culprit-only revascularization in patients with NSTE-ACS and multivessel CAD. METHODS: This was a retrospective observational study that included all patients diagnosed with NSTE-ACS and multivessel CAD who underwent percutaneous coronary intervention (PCI) between January 2010 and June 2013 (n=232). After exclusion of patients with previous coronary artery bypass grafting (n=30), a multivessel revascularization strategy was adopted in 35.1% of patients (n=71); in the others (n=131, 64.9%), only the culprit artery was revascularized. After propensity score matching (PSM), two groups of 66 patients were obtained, matched according to revascularization strategy. RESULTS: During follow-up (1543±545 days), after PSM, patients undergoing multivessel revascularization had lower rates of reinfarction (4.5% vs. 16.7%; log-rank p=0.018), unplanned revascularization (6.1% vs. 16.7%; log-rank p=0.048), unplanned PCI (3.0% vs. 13.6%; log-rank p=0.023) and the combined endpoint of death, reinfarction and unplanned revascularization (16.7 vs. 31.8%; log-rank p=0.046). CONCLUSIONS: In real-world patients presenting with NSTE-ACS and multivessel CAD, a multivessel revascularization strategy was associated with lower rates of reinfarction, unplanned revascularization and unplanned PCI, as well as a reduction in the combined endpoint of death, reinfarction and unplanned revascularization. SN - 2174-2030 UR - https://www.unboundmedicine.com/medline/citation/29486987/Multivessel_vs__culprit_only_revascularization_in_patients_with_non_ST_elevation_acute_coronary_syndromes_and_multivessel_coronary_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0870-2551(17)30095-1 DB - PRIME DP - Unbound Medicine ER -